Sunct syndrome. Report of a case and treatment update

A Historical Note on the Treatment of Trigeminal Neuralgia

Trigeminal neuralgia, otherwise known under the French denomination of tic douloureux, is a chronic painful condition of a particular severity. Its descriptions are numerous and date back to centuries before. Although the anatomy of the trigeminal nerve has been well known, the pathophysiology and hence the treatment of this disease has been largely fortuitous. Disparate pharmacological and surgical approaches have been tried, some of them heralding a much-required therapeutic success. The authors make a brief description of the first sources that have systematized the disease, along with all therapies documented in a written form, especially from indexed journals of the two last centuries. Very few remnants of the previous therapies, actually considered obsolete, have survived to the proof of time; one of them relies on the possible role of the autonomic nervous system and anticholinergic therapies, later replaced from modern conservative and interventional approaches. Anticonvulsants have been, since 1940, the mainstay of the therapy, however, progressions in neurosurgery and mini-invasive procedures have substantially improved the quality of life and the prognosis of an otherwise very painful and chronic condition.

Therapeutical approaches to paroxysmal hemicrania, hemicrania continua and short lasting unilateral neuralgiform headache attacks: a critical appraisal

Background

Hemicrania continua (HC), paroxysmal hemicrania (PH) and short lasting neuralgiform headache attacks (SUNCT and SUNA) are rare syndromes with a difficult therapeutic approach. The aim of this review is to summarize all articles dealing with treatments for HC, PH, SUNCT and SUNA, comparing them in terms of effectiveness and safety.

Methods

A survey was performed using the pubmed database for documents published from the 1st January 1989 onwards. All types of articles were considered, those ones dealing with symptomatic cases and non-English written ones were excluded.

Results

Indomethacin is the best treatment both for HC and PH. For the acute treatment of HC, piroxicam and celecoxib have shown good results, whilst for the prolonged treatment celecoxib, topiramate and gabapentin are good options besides indomethacin. For PH the best drug besides indomethacin is piroxicam, both for acute and prolonged treatment. For SUNCT and SUNA the most effective treatments are intravenous or subcutaneous lidocaine for the acute treatment of active phases and lamotrigine for the their prevention. Other effective therapeutic options are intravenous steroids for acute treatment and topiramate for prolonged treatment. Non-pharmacological techniques have shown good results in SUNCT and SUNA but, since they have been tried on a small number of patients, the reliability of their efficacy is poor and their safety profile mostly unknown.

Conclusions

Besides a great number of treatments tried, HC, PH, SUNCT and SUNA management remains difficult, according with their unknown pathogenesis and their rarity, which strongly limits the studies upon these conditions. Further studies are needed to better define the treatment of choice for these conditions.

Electronic supplementary material

The online version of this article (doi:10.1186/s10194-017-0777-3) contains supplementary material, which is available to authorized users.